Richard C. Niemtzow, MD, PhD, MPH*
Bryon C. May, MD*
Y. Peter Peng, MD*
Warren S. Inouye, MD*
Peter A.S. Johnstone, MD, MA*
*Radiation Oncology Division, Naval Medical Center, 34800 Bob Wilson Drive, Suite 14,
San Diego, CA 92134-1014
ABSTRACT
Twelve head and neck cancer patients developed xerostomia secondary to
radiotherapy. In most cases, this was refractory to conventional pilocarpine therapy.
Acupuncture was offered as a potential palliation of their symptoms. Acupuncture
stimulated saliva secretion to varying degrees.
KEY WORDS
Head, Neck, Cancer, Malignancy, Tumors, Xerostomia, Radiotherapy, Acupuncture,
Saliva, Electro-Auriculotherapy.
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PATIENTS AND METHODS
Twelve patients with refractory xerostomia after radiotherapy were treated with
acupuncture and are the subject of this report.
There is no standard acupuncture protocol for post radiotherapy xerostomia, only
suggested points (1, 2). The acupuncture treatment employed is performed in 2 phases.
Phase 2 is used if Phase 1 is inadequate.
Phase 1: sterile needle (3) inserted bilaterally into LI 2 or 3 (6); auriculotherapy
points: Point Zero, Shen Men, and Salivary Gland (C) II are needled bilaterally. Wait 20
minutes.
If no saliva secretion is apparent, Phase 2 is initiated: the needles at Salivary
Glands (C) II are removed. Electro-stimulation of Salivary Gland(C) II points at 40
microamps @ 10 Hz with an electroauriculotherapy stimulator (4) for 30 seconds bilaterally
is performed. Also, stimulation of Salivary Gland (F) I at 40 microamps @ 10 Hz points for
30 seconds bilaterally is accomplished. Re-needle Salivary Glands (C) II. Stimulate LI 4
bilaterally for 10 seconds using a piezo-electric stimulator (5).
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RESULTS
There were no adverse effects referable to acupuncture. An increased degree of
salivation was subjectively present in all cases after acupuncture. Follow-up evaluations
revealed that the oral buccal mucosa was moist and saliva present. All patients were
capable of expectoration. We recommend that patients be treated with twice-weekly sessions
for 1-2 weeks, then every 3- 4 weeks, depending upon the severity of their cases.
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DISCUSSION
Curative doses of radiation to the head and neck area for malignancies are
fraught with secondary xerostomia. Acupuncture is a stimulation to these patients to
produce saliva. In some patients resistant to pilocarpine therapy, it appears that
acupuncture must activate the salivary glands through another mechanism.
CONCLUSION
Acupuncture using the above protocol may contribute to less xerostomia for patients
with refractory symptoms after radiotherapy. This technique is without side effects and is
considerably less expensive than pharmacological alternatives. Longer follow-up,
optimization of technique, and further prospective objective measurement of saliva
response continue in our clinic. Further research is imperative to optimize acupuncture
techniques for head and neck cancer patients.
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REFERENCES
- Electro-Therapy Association P.O. Box 33189, Tulsa, OK 74153. Auriculotherapy points per
reference (2).
- Auriculotherapy Manual: Chinese and Western Systems of Ear Acupuncture, Terry Oleson,
Ph.D., 2nd edition. Health Care Alternatives (803 Sunset Blvd., #2657, Los
Angeles, CA 90046): 1996, pages 113 and 56.
- Seiren Laser L type needles gauge 3, length 30 mm distributor: OMS Medical Supplies,
Inc., 1950 Washington Street, Braintree, MA 02184.
- Electro-auriculotherapy stimulator: 40A or 400A Stem-Flex, manufactured by Electro
Therapy Association, P.O. Box 33189, Tulsa, OK 74153.
- Piezo Stimulator manufactured by ITO Co. LTD., Tokyo, Japan distributor: OMS Medical
Supplies, Inc., 1950 Washington Street, Braintree, MA, 02184.
- Helms JM. Acupuncture Energetics: A Clinical Approach for Physicians, Berkley, CA:
Medical Acupuncture Publishers: 1995: Page: 684.
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The opinions and assertions contained herein are those of the authors and are not to be
construed as official or representing the views of the United States Navy or Department of
Defense.
Correspondence and reprint requests to: Dr Richard C. Niemtzow, Radiation Oncology
Division, Naval Medical Center, 34800 Bob Wilson Dr., Suite 14, San Diego, CA 92134-1014.
Phone: 619-532-7274; Fax: 619-532-8178; E-mail: N5EV@msn.COM
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